Electromagnetic energy output system

ABSTRACT

An apparatus having an excitation source that includes at least one laser diode and also having a handpiece with a disposable, bendable tip cannula is disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.11/800,434, filed May 3, 2007 and entitled ELECTROMAGNETIC ENERGY OUTPUTSYSTEM (Att. Docket BI9975CIP), which claims priority to U.S.Provisional Application No. 60/898,022, filed on Jan. 26, 2007 (Att.Docket BI9827CIPPR) and which is a continuation-in-part of U.S.application Ser. No. 11/698,345, filed Jan. 25, 2007 and entitledELECTROMAGNETIC ENERGY OUTPUT SYSTEM (Att. Docket BI9975P), the entirecontents all of which are hereby incorporated by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to devices for generating outputoptical energy distributions and, more particularly, to lasers.

2. Description of Related Art

A variety of laser systems have existed in the prior art. A solid-statelaser system generally comprises a laser rod for emitting coherent lightand a stimulation source for stimulating the laser rod to emit thecoherent light. Flashlamps are typically used as stimulation sources forlaser systems, for example, but diodes may be used as well for theexcitation source. The use of diodes for generating light amplificationby stimulated emission is discussed in the book Solid-State LaserEngineering, Fourth Extensively Revised and Updated Edition, by WalterKoechner, published in 1996, the contents of which are expresslyincorporated herein by reference.

With reference to FIG. 1, a conventional laser assembly 25 may comprisea housing 27 containing a laser module 29, which is connected by way ofan optical connector 31 to a trunk fiber 33. The optical connector 31 istypically disposed within and concealed by a portion of the housing 27and, further, is typically constructed to facilitate attachment andremoval of the trunk fiber 33 to and from the housing 27. Moreover, inthe illustrated prior-art example, the trunk fiber 33 extends in anuninterrupted fashion from the housing 27 up to and through a handpiece35. Furthermore, the trunk fiber 33 continues in an uninterruptedfashion from the handpiece 35 through a pre-bent tip cannula 38 andterminates at an energy output end 40 of the trunk fiber 33. Thepre-bent tip cannula 38 comprises a rigid plastic or a stainless steelmaterial.

A spool (not shown) can be disposed in close proximity to the opticalconnector 31, for storing extra trunk fiber 33. The spool can be securedto the housing 27 to provide a user with access and to enable the userto increase a length of the trunk fiber 33 by advancing addition trunkfiber 33 from the spool toward the handpiece 35. In typicalimplementations, the energy output end 40 of the trunk fiber 33 canexhibit signs of wear or damage after use, and thus should be replacedon a regular and frequent basis. To this end, after each use, the userwill typically need to cleave a portion (e.g., between 3 and 10millimeters) off of the energy output end 40 of the trunk fiber 33 andadvance an additional length of trunk fiber 33 from the spool tocompensate for the decrease in length of the trunk fiber 33 caused bythe cleaving. Of course, to facilitate this functionality, the trunkfiber 33 must be slidably disposed, and cannot be permanently affixedsuch as by an adhesive, within the pre-pent tip cannula 38. Using thistechnique, a trunk fiber 33 length of, for example, 10 to 12 feet can bemaintained. Additionally, for sanitation purposes, the pre-bent tipcannula and any other appropriate components are typically sterilized,such as by autoclaving, on a regular and frequent basis.

FIG. 2 illustrates a plot of energy versus time for an output opticalenergy waveform 43 of a prior-art laser, such as the conventional laserassembly 25 depicted in FIG. 1. The output optical energy waveform 43may be generated by a compact diode laser, such as a SIROlaser,manufactured by Sirona Dental Systems GmbH, of Germany, having a URL ofwww.sirona.com, operable at a wavelength of 980 nanometers and arepetition rate of about 10 kHz, and having an average power output,defined as the power delivered over a predetermined period of time,varying from 0.5 to 7 W. Each pulse of the depicted output opticalenergy waveform 43 has a pulse duration 46 and a pulse interval 48. Inthe illustrated example, the output optical energy waveform 43 can begenerated such that the pulse duration 46 can have a value of about 50microseconds and the pulse interval 48 can also have a value of about 50microseconds. According to the exemplary depiction, the output opticalenergy waveform 43 can be said to have a pulse period 51 of about 100microseconds, and, furthermore, the output optical energy waveform 43can be said to have a pulse duty cycle, defined as the pulse duration 46divided by the pulse interval 48, of about 50%. The pulse duration 46and the pulse duration 48 of this exemplary prior-art system cannot beindependently adjusted.

Another prior-art system is the LaserSmile™ laser, manufactured byBiolase Technology, Inc., of Irvine, Calif., having a URL ofwww.biolase.com. This laser can be operated at a wavelength of 810nanometers and a repetition rate of, for example, about 0.01 to about 5Hz, with corresponding pulse durations of about 0.02 to about 9.9seconds, and with an average power output up to about 10 W. Outputoptical energy waveforms from the laser can have pulse duty cycles of,for example, between 10% and 50%. Additionally, while beingindependently adjustable, the pulse duration and pulse interval of thelaser's output optical energy waveform tend to be relatively large andnot adequately or optimally suited for a number of soft tissue cuttingprocedures, such as procedures designed to minimize an impartation ofthermal energy into the target soft tissue.

SUMMARY OF THE INVENTION

The present invention provides an apparatus having an excitation sourcethat includes at least one laser diode and also having a handpiece witha disposable, bendable tip cannula.

While the apparatus and method have or will be described for the sake ofgrammatical fluidity with functional explanations, it is to be expresslyunderstood that the claims, unless expressly formulated under 35 USC112, are not to be construed as necessarily limited in any way by theconstruction of “means” or “steps” limitations, but are to be accordedthe full scope of the meaning and equivalents of the definition providedby the claims under the judicial doctrine of equivalents, and in thecase where the claims are expressly formulated under 35 USC 112 are tobe accorded full statutory equivalents under 35 USC 112.

Any feature or combination of features described herein are includedwithin the scope of the present invention provided that the featuresincluded in any such combination are not mutually inconsistent as willbe apparent from the context, this specification, and the knowledge ofone skilled in the art. In addition, any feature or combination offeatures may be specifically excluded from any embodiment of the presentinvention. For purposes of summarizing the present invention, certainaspects, advantages and novel features of the present invention aredescribed. Of course, it is to be understood that not necessarily allsuch aspects, advantages or features will be embodied in any particularimplementation of the present invention. Additional advantages andaspects of the present invention are apparent in the following detaileddescription and claims that follow.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a conventional laser assembly;

FIG. 2 illustrates a plot of energy versus time for an output opticalenergy waveform of a prior-art laser;

FIG. 3 depicts an electromagnetic energy output device according to thepresent invention;

FIGS. 4A and 5 illustrate plots of energy versus time for output opticalenergy waveforms, according to the present invention, that can beoutputted by an electromagnetic energy output system such as the lasermodule depicted in FIG. 3;

FIG. 4B is a magnified view of the plot of energy versus time for theoutput optical energy waveform of FIG. 4A;

FIG. 6 is a side-elevation view of an exemplary output tip comprising anoutput fiberoptic, a bendable tip cannula, and a ferrule;

FIG. 7 is a cross-sectional view of the output tip shown in FIG. 6,secured to a handpiece;

FIG. 8A is a side-elevation view of the output tip of FIG. 6 connectedto a handpiece;

FIG. 8B is a cross-sectional view of the assembly of FIG. 8A;

FIG. 9A shows a side-elevation view of an outer layer of the handpieceof FIGS. 8A and 8B;

FIG. 9B shows a side-elevation view of the outer layer along with acoupling member;

FIG. 9C shows a side-elevation view of the outer layer and couplingmember, a cross-sectional view of the outer layer and coupling member,and a perspective view of the outer layer;

FIG. 10 is a magnified view of portions of the structure of FIG. 8B;

FIG. 10A is a perspective view depicting an inner assembly, which isalso shown in FIG. 8B and which includes the output tip;

FIG. 10B is an exploded, perspective view of the assembly of FIG. 10A;

FIG. 10C is a partially-assembled view of the components depicted inFIG. 10B;

FIG. 11 is a schematic representation of the portion depicted in FIG.10;

FIG. 12 is a schematic representation of the portion depicted in FIG. 10according to a modified embodiment;

FIGS. 12A, 12B, 12C and 12D show perspective, lengthwisecross-sectional, front-end, and transverse cross-sectional views ofcomponents including a ferrule 112 corresponding to the representationof FIG. 12;

FIGS. 12E and 12F show side-elevation views of components including aferrule and an output fiberoptic 107;

FIG. 12G shows a perspective view of components including a ferrule andan output fiberoptic 107, with an aiming beam in an “on” state so thatexposed parts of the output fiberoptic and ferrule glow;

FIG. 12H provides schematic representations of aiming-beamcharacteristics, of a portion of structure depicted in FIG. 10, and oflaser and aiming-beam spots projected onto the input end of an outputfiberoptic;

FIG. 13 depicts an irradiation pattern that may be generated and outputfrom the embodiment of FIG. 12;

FIG. 14 shows examples of a number of typical bendable tip cannulasaccording to the present invention;

FIG. 15 depicts a body-mount implementation of an electromagnetic energyoutput device according to an aspect of the present invention;

FIGS. 16 and 17 are perspective front and rear views, according to anaspect of the present invention, of an electromagnetic energy outputdevice in the form of a compact, portable assembly that can be carriedor mounted with relative ease by a user;

FIG. 18 shows the electromagnetic energy output device of FIGS. 16 and17 in a wall-mount configuration according to an aspect of the presentinvention;

FIG. 19 shows the electromagnetic energy output device of FIGS. 16 and17 with a detached base according to an aspect of the present invention;

FIG. 20A shows the electromagnetic energy output device of FIGS. 16 and17, disposed on a flat surface such as a table top according to anaspect of the present invention;

FIG. 20B is a rear view of the electromagnetic energy output device ofFIGS. 16 and 17, held by a hand of a user according to another aspect ofthe present invention;

FIGS. 21, 22, 23, 24, 25A and 25B depict various perspective views ofspool structures and associated techniques corresponding to aspects ofthe present invention; and

FIGS. 26A-26B depict front and rear perspective views of a modified-baseimplementation according to an aspect of the present invention.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

Reference will now be made in detail to particular embodiments of theinvention, examples of which are illustrated in the accompanyingdrawings. Wherever possible, the same or similar reference numbers areused in the drawings and the description to refer to the same or likeparts. It should be noted that the drawings are in simplified form andare not to precise scale. In reference to the disclosure herein, forpurposes of convenience and clarity only, directional terms, such as,top, bottom, left, right, up, down, over, above, below, beneath, rear,and front, are used with respect to the accompanying drawings. Suchdirectional terms should not be construed to limit the scope of theinvention in any manner.

Although the disclosure herein refers to certain illustratedembodiments, it is to be understood that these embodiments are presentedby way of example and not by way of limitation. The intent of thisdisclosure, while discussing exemplary embodiments, is that thefollowing detailed description be construed to cover all modifications,alternatives, and equivalents of the embodiments as may fall within thespirit and scope of the invention as defined by the appended claims.

An electromagnetic energy output device is disclosed for implementingprocedures on hard or soft tissue. The electromagnetic energy outputdevice can be configured, for example, to be particularly suited forsoft tissue cutting or ablating procedures, and also fordecontamination, cleaning periodontal pockets, pain reduction, andbiostimulation procedures.

With reference to FIG. 3, an embodiment of the current inventioncomprises an electromagnetic energy output device 65 having a system 67,such as a diode laser system. The system 67 in the illustratedembodiment can comprise a laser module 69, which, in accordance with oneaspect of the present invention, can be directly coupled to a trunkoptical fiber 73. According to one implementation and one aspect of theinvention, the trunk optical fiber 73 can be permanently coupled to thesystem 67. According to another embodiment and aspect of the invention,the trunk optical fiber 73 can also, or alternatively, be permanentlycoupled to the laser module 69 within the system 67.

The trunk optical fiber 73 in the illustrated embodiment, and accordingto another aspect of the invention, extends from a permanent connection75 at the laser module 69 all of the way to a handpiece 78. Furthermore,in a typical embodiment, the trunk optical fiber 73 extends a furtherdistance through at least a part of the handpiece 78. In the illustratedembodiment, the trunk optical fiber 73 extends through substantially allof the handpiece 78 and terminates at an energy output end 80 of thetrunk fiber 73, in a vicinity of a distal handpiece end 81 of thehandpiece 78.

A diode (not shown) within the laser module 69 can be driven by a diodecurrent, which can comprise a predetermined pulse shape and apredetermined frequency. The diode current can drive a diode, or diodearray, at the predetermined frequency, to thereby produce an outputdiode light distribution having, for example, substantially the samefrequency as the diode current. This output diode light distributionfrom the diode can drive a laser rod (not shown) to produce coherentlight at substantially the same predetermined frequency as the diodecurrent. The coherent light generated by the laser rod can have, forexample, an output optical energy distribution over time that generallycorresponds to the pulse shape of the diode current. The pulse shape ofthe output optical energy distribution over time typically comprise arelatively steep rising energy that ramps to a maximum energy levelfollowed by a subsequent decreasing energy over time.

The laser module 69 may comprise a solid-state laser rod pumping moduleand a stack-type semiconductor laser. The semiconductor laser can bebased on a semiconductor gain media, where optical gain is generallyachieved by stimulated emission at an interband transition underconditions of an inversion (i.e., high carrier density in the conductionband). The semiconductor laser can be a laser diode, which is pumped byan electrical current in a region where n-doped and p-dopedsemiconductor materials meet. In certain embodiments, optically pumpedsemiconductor lasers, where carriers are generated by absorbed pumplight, can be used. In the case of, for example, a stack-typesemiconductor laser, it can include a plurality of bar-shaped componentsthat are stacked in a direction parallel to the axis of a solid-statelaser rod. Each bar-shaped component can include a plurality oflaser-light-emitting portions that are aligned and integrated in adirection orthogonal to the axis of the solid-state laser rod. The largedivergence angle of the stack-type semiconductor can be compensated byincluding a light focusing component for focusing laser light emittedout of the stack-type semiconductor laser, and the focused light can beguided by a laser light guiding component disposed in a diffusivereflection tube. Thus, a light guiding component can guide focused lightonto the solid-state laser rod located within the diffusive reflectivetube, while maintaining the length of one side of the cross section ofthe guided light.

The semiconductor laser or other optoelectronic device can comprise, forexample, an Indium Gallium Arsenide (GaAs) material. In an exemplaryimplementation, the gain medium can comprise a laser rod, such as aconfiguration comprising an active heterostructure and substrate ofAlGa(In)As/GaAs, wherein the Ga of the active heterostructure can besubstituted for and/or combined with In. Another exemplaryimplementation can comprise AlGaInP(As)/GaAs, wherein the P of theactive heterostructure can be substituted for and/or combined.

FIG. 4A illustrates a plot of energy versus time for an output opticalenergy waveform 93, according to the present invention, that can beoutputted by an electromagnetic energy output system, such as the lasermodule 69 depicted in FIG. 3. FIG. 4B is a magnified view of the plot ofenergy versus time for the output optical energy waveform 93 of FIG. 4A.

Each of the pulses of the output optical energy waveform 93 comprises aplurality of micropulses. The micropulses correspond to populationinversions within the laser rod as coherent light is generated bystimulated emission. Particles, such as electrons, associated withimpurities of the laser rod absorb energy from the impinging incoherentradiation and rise to higher valence states. The particles that rise tometastable levels remain at this level for periods of time until, forexample, energy particles of the radiation excite stimulatedtransitions. The stimulation of a particle in the metastable level by anenergy particle results in both of the particles decaying to a groundstate and an emission of twin coherent photons (particles of energy).The twin coherent photons can resonate through the laser rod betweenmirrors at opposing ends of the laser rod, and can stimulate otherparticles on the metastable level, to thereby generate subsequent twincoherent photon emissions. This process is referred to as lightamplification by stimulated emission. With this process, a twin pair ofcoherent photons will contact two particles on the metastable level, tothereby yield four coherent photons. Subsequently, the four coherentphotons will collide with other particles on the metastable level tothereby yield eight coherent photons.

The amplification effect will continue until a majority of particles,which were raised to the metastable level by the stimulating incoherentlight from the diode, have decayed back to the ground state. The decayof a majority of particles from the metastable state to the ground stateresults in the generation of a large number of photons, corresponding toan upwardly rising micropulse. As the particles on the ground level areagain stimulated back up to the metastable state, the number of photonsbeing emitted decreases, corresponding to a downward slope in themicropulse. The micropulse continues to decline, corresponding to adecrease in the emission of coherent photons by the laser system. Thenumber of particles stimulated to the metastable level increases to anamount where the stimulated emissions occur at a level sufficient toincrease the number of coherent photons generated. As the generation ofcoherent photons increases, and particles on the metastable level decay,the number of coherent photons increases, corresponding to an upwardlyrising micropulse.

The output optical energy waveform 93 according to an aspect of theinvention is generated by a diode laser to have a wavelength, pulse, andpower density suitable for cutting and ablating, for example, softtissue. The diode light pump or the at least one diode can comprise adiode array, and the diode or diode array can be optically aligned toside pump the gain medium. In one implementation, the diode light pumpcan be placed, for example, within an optical cavity so that the diodeor diode array is optically aligned to side pump the gain medium.Generation of the output optical energy waveform 93 can be accomplished,for example, in the TEMoo mode to attenuate or overcome thermal effects.

With reference to FIGS. 4A and 4B, the output optical energy waveform 93according to an aspect of the invention is generated by a diode laser tohave a wavelength of 940 microseconds, and can be delivered, forexample, in a CW (continuous wave) or a QCW (quasi-continuous wave) modeof operation. As presently embodied, the output optical energy waveform93 is delivered in a pulsed-format mode of operation that is highlyrepetitive in time and intensity to provide, for example, relativelyprecise and predictable cutting. As compared, for example, to awavelength of 810 microseconds, with other things being equal, thewavelength of 940 microseconds has been determined by the presentinventors to have an absorption that is about four times greater forwater, two times greater for hemoglobin (for enhanced homeostasis) andabout 20% greater for oxyhemoglobin. Alternative wavelengths which canbe used according to modified aspects of the present invention can be,for example, 915 microseconds, 960 microseconds and 980 microseconds.Other alternative wavelengths which can be used in other modifiedaspects of the invention can comprise the mentioned wavelengths, plus orminus about 50 nanometers.

As shown in FIG. 4A, each pulse of the output optical energy waveform 93can comprise, for example, a pulse duration 96 of about 50 microseconds,a pulse interval 98 of about 450 microseconds, and a pulse period ofabout 500 microseconds. The magnified view of a pulse featured in FIG.4B shows that the pulse duration 96 has room for being further reducedin duration. For example, the pulse duration 96 can, according tocertain embodiments, be reduced from about 50 microseconds all of theway down to about 10 microseconds. Thus, as illustrated, the outputoptical energy waveform 93 can comprise a repetition rate of about 2kHz. The average power output, defined as the power delivered over apredetermined period of time, can be about 1 W. The repetition rate canalso be, for example, about 10 kHz, corresponding to a pulse period ofabout 100 microseconds. The full-width half-max of the pulse may beabout 50 to 100 microseconds. In accordance with a typical embodiment,the repetition rate can be varied from about 1 kHz to about 5 kHz, andthe average power output can be varied from about 0.5 W to about 1.5 W.In typical embodiments, the pulse length can be varied from about 50microseconds to about 1000 microseconds, and the pulse interval can bevaried from about 100 microseconds to about 2000 microseconds, whichparameters may correspond, for example, to pulse repetition rates ofabout 0.5 kHz to about 5 kHz. The depicted output optical energywaveform 93 thus has a pulse duration 96 and a pulse interval 98 whichare both on the order of tens of microseconds. The pulse period isindicated with reference designator number 101 in the depiction of FIG.4A. FIG. 5 shows an output optical energy waveform 104 comprising, forexample, a pulse duration 106 of about 500 microseconds and a pulseinterval 110 of about 50 microseconds.

According to the present invention, the system 67 of the currentinvention can be configured to implement output optical energy waveforms93 that minimize an impartation of thermal energy into the target tissue(e.g., soft tissue). As an example, the thermal diffusion time, orthermal relaxation time, for highly-absorbing soft tissue is about 150to 200 microseconds. Thus, according to an aspect of the presentinvention, for certain applications, the pulse duration of the opticalbeam (e.g., the output optical energy waveforms 93) can be approximatelyequal to or less than the thermal relaxation time, which will help toconfine or limit the amount of energy dissipation, or the area ofthermal affection, of the impingent energy footprint on or within thetreatment area. Pulse durations that are longer than the thermalrelaxation time can be less efficient and cause the spot to undesirablygrow by thermal diffusion. In one implementation, the pulse duration isset to have a value (e.g., 50 microseconds) that is less than thethermal relaxation time. In another implementation, the pulse intervalis set to have a value (e.g., 450 microseconds) that is equal to orgreater than the thermal relaxation time. Another implementation cancomprise a combination of these two aspects, wherein the pulse durationcan be set to be below the thermal relaxation time and the pulseinterval can be set to be equal to or greater than the thermalrelaxation time.

According to another aspect of the present invention, the output opticalenergy waveform 93 can be varied by way of independent adjustments toone or more of the pulse duration 96 and the pulse interval 98. By wayof providing independent adjustments to one or more of the pulseduration 96 and the pulse interval 98, and, preferably, both, the pulseduty cycle, defined as the pulse duration 96 divided by the pulseinterval 98, can be controlled. As presently embodied, the pulse dutycycle can be adjusted from, for example, about 5% to about 95%. Inparticular implementations, it may be varied, for example, from about10% to about 50%. Thus, the pulse duration can be set, independently of,for example, the pulse interval, to have a value (e.g., 50 microseconds)that is below the thermal relaxation time; the pulse interval can beset, independently of, for example, the pulse duration, to have a value(e.g., 450 microseconds) that is equal to or longer than the thermalrelaxation time; and/or the pulse duration and pulse interval can be setto be below, and equal to or greater than, the thermal relaxation time,respectively, to approach or achieve, for example, a characteristicreferred to as cold cutting.

Setting of the pulse duration and pulse interval as described in theforegoing paragraph can facilitate a type of cold-cutting tissueinteraction. Cold cutting may bring about certain characteristics oradvantages, as discussed below, while, on the other hand, noncold-cutting modes, or intermediate modes, may bring about additionalcharacteristics or advantages, a few of which are discussed below.

By controlling one or more of the pulse duration 96 and the pulseinterval 98, various procedural properties, such as bleeding, can becontrolled. For example, increasing the pulse duration independent of,for example, the pulse repetition rate, can operate to decrease bleedingor increase coagulation, as a result of proving a greater thermic effectto the target. The effect of such a mode (e.g., a thermic effect, whichmay tend, for example, to augment coagulation) can in some instancescreate greater scar tissue and/or impede the speed or quality of healingof a target. On the other hand, generating a cooler-cutting (e.g., coldcutting) effect, by, for example, outputting optical energy waveform 93with a reduced pulse duty cycle (and/or, for example, setting the pulseduration and/or pulse interval below, and/or equal to or greater than,the thermal relaxation time, respectively, as described herein) mayenable a treated region to heal better or faster, and/or may facilitateimplementation of a procedure with less pain to the patient.

Referring back to FIG. 3, an optical interface can be disposed at atermination of the trunk optical fiber 73 near the distal handpiece end81, wherein the optical interface can be constructed to provide anoptical pathway between the trunk optical fiber 73 and an outputfiberoptic 107 of an output tip 108. Thus, as presently embodied, thetrunk fiber 73 can extend in an uninterrupted fashion from the system 67up to and through the handpiece 78, terminating at or near the opticalinterface, which, in turn, can be located at or near the handpiecedistal end 81.

The optical interface can be disposed, for example, within and concealedwithin the handpiece distal end 81 as illustrated. The output tip 108can be removable in accordance with an aspect of the present invention.In a number of such embodiments, the handpiece distal end 81 and theoutput tip 108 can be constructed to interact in such a way as tofacilitate convenient and rapid attachment and removal of the output tip108 to and from the handpiece 78. The output tip 108 can additionally,or alternatively, be removed and interchanged with other output tips inaccordance with an aspect of the present invention.

According to another aspect of the current invention, the output tip 108can additionally, or alternatively, comprise a bendable tip cannula 109.Furthermore, according to yet another aspect of the invention, theoutput tip 108 can additionally, or alternatively, comprise a disposableoutput tip 108, which may or may not (according to various,non-interchangeable embodiments) comprise a cannula, which may or maynot (according to various, non-interchangeable embodiments) be bendable.In the case of a bendable tip cannula 109, it may comprise a pliablematerial, such as a pliable metal. According to typical implementationsof the bendable tip cannula 109, the bendable tip cannula 109 can bebent at any angle, can have various diameters and lengths, and/or can bepackaged, for example, pre-sterilized in a sealed, sterile package.

Regarding such a bendable tip cannula 109, the pliable material maycomprise, for example, a treated stainless steel material. The stainlesssteel material may be treated to make it bendable and/or to make it morereadily bendable without kinking Following an exemplary treatment of thebendable tip cannula 109 while, for example, the bendable tip cannula109 is in a pre-bent orientation (or following treatment of the materialused to make the cannula before the cannula is formed), the bendable tipcannula 109 can be bent one or more times while remaining operable. Incertain implementations, the bendable tip cannula 109 can benon-destructively bent multiple times at various angles (e.g., 30degrees, or 45 degrees) up to about 90 degrees from the pre-bent(straight) orientation, at about a 2 or 2.5 mm radius of curvature,without damage to structure or function. A 2 mm radius of curvature maybe obtained, for example, by bending the bendable tip cannula around acylindrical object having a diameter of about 4 mm.

In other implementations, the bendable tip cannula 109 can benon-destructively bent multiple times at various angles up to about 120degrees from the pre-bent (straight) orientation, at a 2.5 mm radius ofcurvature, without damage to structure or function of the bendable tipcannula. A 2.5 mm radius of curvature may be obtained, for example, bybending the bendable tip cannula around a cylindrical object having adiameter of about 5 mm.

In further implementations, the bendable tip cannula 109 can benon-destructively bent a relatively large number of times, at any of thereferenced angles and radiuses of curvatures, without affect to orattenuation in function. Other embodiments encompass bending thebendable tip cannula 109 a relatively large number of times, at any ofthe referenced angles and radiuses of curvatures, without compromise toits ability to operate in its normal or intended capability.

According to other implementations, the bendable tip cannula 109 can bebent a relatively large number of times to a maximum angle of about 120degrees from the pre-bent (straight) orientation, at a radius ofcurvature of about 2.5 mm, while remaining fully, or in otherembodiments substantially, or in other embodiments adequately, operable.In a typical embodiment, the relatively large number can be three, fouror five, but in modified embodiments smaller or larger numbers can beimplemented. A bendable stainless steel material that may be used toform the bendable tip cannula 109 can be obtained or purchased as aMetric Hypodermic Tube (e.g., Gage Sizes 18, 19 or 20) from New EnglandSmall Tube Corporation, of Litchfield, N.H.

A side-elevation view of an exemplary output tip 108, comprising anoutput fiberoptic 107, a bendable tip cannula 109 and a ferrule 112 withthreads 113 a, is depicted in FIG. 6. The ferrule 112 may comprise, forexample, plastic (e.g., acrylic or polycarbonate) that is, for example,transparent to the laser beam. A cross-sectional view of this output tip108, secured to the handpiece 78 via, for example, engagement of threads113 a of the output tip 108 with corresponding threads 113 b of an outerlayer 116 a of the handpiece 78, is shown in FIG. 7. FIG. 8A is aside-elevation view of the output tip 108 connected to the handpiece 78,and FIG. 8B is a cross-sectional view of the assembly of FIG. 8A. FIG.9A shows a side-elevation view of an outer layer 116 a of the handpiece87; FIG. 9B shows a side-elevation view of the outer layer 116 a alongwith a coupling member 116 b; and FIG. 9C shows a side-elevation view ofthe outer layer 116 a and coupling member 116 b, a cross-sectional viewof the outer layer 116 a and coupling member 116 b, and a perspectiveview of the outer layer 116 a.

As can be discerned from FIGS. 8B, 9B and 10A, the outer layer 116 a andcoupling member 116 b can be secured over an inner assembly 117including the output tip 108, cf. FIG. 10A, by moving the outer layer116 a and coupling member 116 b proximally over the inner assembly 117(i.e., moving over and around the output tip 108 and progressingproximally to a proximal end of the inner assembly 117). The threads 113a/113 b can then be coupled and, further, protuberances 120 a of theinner assembly 117 can be disposed within a recessed area 120 b of theouter layer 116 a. Release buttons 121 can be pressed by a hand of auser to release the protuberences 120 a from within the recessed area120 b to facilitate removal of the inner assembly 117 from within theouter layer 116 a and coupling member 116 b.

FIG. 10 is a magnified view of portions of the structure of FIG. 8B, andFIG. 10A is a perspective view of portions of the structure of FIG. 8B.The perspective view of FIG. 10A depicts the inner assembly 117including the output tip 108. FIG. 10B is an exploded, perspective viewof the assembly of FIG. 10A, and FIG. 10C is a partially-assembled viewof the components depicted in FIG. 10B. FIG. 11 is a schematicrepresentation of the portion depicted in FIG. 10.

As elucidated in FIG. 10, the optical interface can comprise, forexample, a physical barrier that is optically transparent, such as awindow 114 shown in FIGS. 10-12. An O-ring 118 can be used to facilitatepositioning and/or stabilization of the window 114. Additionally, oralternatively, one or more of the ferrule 112 and a similarly-shaped(e.g., of similar or the same material) ferrule 119 can function tocontact one or more corresponding sides of the window 114. The window114 can be readily removable and field replaceable using an attachmentscheme that does not rely on adhesives or permanent formations, whereinremoval of the output tip 108, ferrule 112, and/or additional componentscan provide access to the window 114 for removal or insertion thereof.Although modified implementations of the optical interface may compriselenses or other optical elements on one or both sides (e.g., proximaland distal sides) of the optical interface, the illustrated embodimentcomprises neither. According to this illustrated implementation andaspect of the invention, lens structure or functionality is not providedon either side of the window 114 to attenuate a risk of, for example,misalignment, leaking, and/or damage when the output tip 108 isinserted, removed or otherwise repositioned.

As can be seen from a review of FIGS. 10 and 11, each of the trunkoptical fiber 73, which is shown in FIG. 10 disposed within a channel 73a, and the output fiberoptic 107, which is shown in FIG. 10 comprising aglass fiber 107 a encompassed within a jacket 107 b (e.g., a Teflon orpolyethylene jacket), can be spaced from a corresponding surface of thewindow 114. In the illustrated implementation, each of the trunk opticalfiber 73 and the output fiberoptic 107 can be spaced about 100 micronsfrom a corresponding surface of the window 114. A point on the perimeterof the distal end (i.e., output surface) of the trunk optical fiber 73can be referred to as a beginning point. Referring to FIG. 11, an angleof divergence A1, measured between the optical axis of the trunk opticalfiber 73 and a path of output energy extending from the beginning pointto an edge (i.e., perimeter edge) of the proximal end of the outputfiberoptic 107, can be about eight degrees. Although the proximal inputend of the output fiberoptic 107 does not contact the window 114,intermediate or outer portions of the ferrule 112 do, as can be seen inFIG. 10, to thereby ensure exact positioning of the output tip 108 witheach insertion of each output tip 108. In a modified embodiment, apush/twist/lock design, or a click or snap design, can be implementedinstead of the illustrated threaded design for securing the output tip108 to the handpiece 78.

In the depictions of, for example, FIGS. 7 and 10, an air gap 111 isdisposed between the output fiberoptic 107 and the bendable tip cannula109. FIG. 7 shows an embodiment wherein an aiming beam fiber 115delivers radiation to the optical interface (e.g., window 114) at a anangle or at a relatively steep angle (e.g., up to about 30 degrees, orup to about 45 degrees, or up to about 60 degrees, compared to the trunkoptical fiber 73 axis), and further depicts another (e.g., alternative)embodiment wherein the aiming beam 115 a delivers radiation to theoptical interface 114 along an axis that is substantially parallel tothe trunk optical fiber 73. Furthermore, in the illustrated embodimentsof, for example, FIGS. 7 and 10, an air gap 111 a is disposed betweenthe distal end of the aiming beam fiber 115 (or 115 a) and the proximalside of the window 114 and is further disposed between the distal end ofthe trunk optical fiber 73 and the proximal side of the window 114.Moreover, in this illustrated embodiment, another air gap 111 b isdisposed between the distal side of the window 114 and the proximal endof the output fiberoptic 107.

FIG. 12 is a schematic representation of the portion depicted in FIG. 10according to a modified embodiment, and FIG. 13 depicts an irradiationpattern that may be generated and output from the modified embodiment ofFIG. 12. In this embodiment, instead of the aiming beam fiber 115 beingconfigured to deliver radiation to the optical interface (e.g., window114) at a relatively steep angle as shown in FIG. 10, the aiming beamfiber 115 can be constructed to deliver radiation to the opticalinterface along a path that is substantially parallel to the trunkoptical fiber 73. In either implementation, aiming-beam light strikingwindow 114 inherently results in a portion of that light being deflected(e.g., leaking) into the ferrule 112. Now, when the ferrule 112 isformed of a material transparent to the laser beam, as mentioned above,the aiming-beam light (comprising visible light) within the ferrule 112can be seen by a user, resulting in an appearance of the ferrule 112glowing with, for example, the color of the aiming beam light. Accordingto one aspect of the present invention, introducing disturbances orother light deflecting structures or compositions within the ferrule 112and/or on the surface of the ferrule 112 (and/or increasing or alteringthe amount or angle, or, potentially, other aspects or characteristics)of aiming-beam light entering the ferrule 112 can alter (e.g., enhance,augment, or dramatically enhance) the glowing appearance of the ferrule112. For instance, the ferrule 112 may be constructed to have differentdegrees of transparency and/or different colors wherein ferrules (ofreplaceable output tips) can be formed to have increasing levels oftransparency and/or different colors. In FIG. 12F, the top, bottom-rightand bottom-left ferrules can be formed, for example, to have a bluetint, a yellow tint and no tint, respectively.

Furthermore, when another portion of the aiming-beam light is directedinto the glass fiber 107 a, as discussed previously, this other portionof light travels to the distal, output end of the glass fiber 107 a andcan be seen by a user, resulting in an appearance of the distal, outputend of the output fiberoptic 107 (e.g., the exposed glass fiber 107 a)glowing with the color of the aiming beam light. According to an aspectof the present invention, introducing surface disturbances or otheralterations in structure or material within or on the surface of thedistal, output end of the glass fiber 107 a can alter (e.g., enhance,augment, or dramatically enhance) the glowing appearance of the distal,output end of the glass fiber 107 a. For instance, the glass fiber 107 amay be constructed to have different degrees of transparency and/ordifferent colors. In a typical embodiment, however, the glass fiber 107a is formed of a material that is entirely or substantially completelytransparent to the cutting-beam wavelength (e.g., 940 nm).

As presently embodied, the jacket 107 b can be constructed, for example,to be transparent or semi-transparent, to thereby exhibit a glowingappearance corresponding to the color of the aiming beam light.According to an aspect of the present invention, introducing surfacedisturbances or other alterations in structure or material within or onthe surface of the jacket 107 b can alter (e.g., enhance, augment, ordramatically enhance) the glowing appearance of the jacket 107 b. As anexample, the jacket 107 b may be constructed to have different degreesof transparency and/or different colors.

In any of the preceding embodiments, the color, brightness or otherparameter of the aiming beam may be varied to provide a different visualeffect. Typically, the aiming beam can have a red color, and this can beused with ferrules having clear transparencies (corresponding, forexample, to a color and transparency of water) or transparencies withslight hues of one or more colors, such as, for example, a transparentyellow ferrule).

FIGS. 12A, 12B, 12C and 12D show perspective, lengthwisecross-sectional, front-end, and transverse cross-sectional views ofcomponents (including ferrule 112) corresponding to the embodiment ofFIG. 12.

FIGS. 12E and 12F show side-elevation views of components (includingferrule 112 and output fiberoptic 107), and FIG. 12G shows a perspectiveview of components (including ferrule 112 and output fiberoptic 107) butwith the aiming beam “on” so that exposed parts of the output fiberopticand ferrule glow. According to one aspect of the present invention, thematerial of the ferrule can have a transparency of at least about 50%.According to another aspect, a transparency of the material of theferrule can be selected to be sufficient to allow a human naked eye tosee (e.g., clearly see) the bendable cannula 109 within the ferrule(c.f., lower-left fiberoptic of FIG. 12F).

The material of the ferrule 112, when formed into a planar sheet withsmooth surfaces and a thickness of about 5 mm, can have a 50%transparency, meaning, as used herein, that it will transmit about 50%of light from the cutting-beam laser (e.g., laser light having awavelength of 940 microns). This transparency may be altered, such as,for example, increased to any value up to a 100% transparency. Atransparency of the non-tinted ferrule of the lower-left replaceableoutput tip 108 shown in FIG. 12F can be (e.g., is) about 80% to 90%.

In a particular embodiment, about 85% of the cutting-beam laser lightexiting from the window 114 enters into the output fiberoptic 107 andabout 8% of it enters into the ferrule 112. Within the ferrule, abouthalf of it is absorbed and about half passes through.

Regarding the aiming beam, in a particular embodiment, about 50% of theaiming beam exiting from the window 114 enters into the outputfiberoptic 107 (cf. bottom-right depiction of FIG. 12H) and about 50% ofit enters into the ferrule 112. In one embodiment, within the ferrule, apercentage (e.g., about half) of it is absorbed and another percentage(e.g., about half) passes through, to create a glowing effect.

With reference to FIG. 12H, the solid cross-hairs at the center of theoutput fiberoptic (fiber) indicate an optical center thereof. Thesesolid cross-hairs also correspond to an optical center of thecutting-beam radiation (laser) that is projected onto the input end ofoutput fiberoptic. The phantom cross-hairs indicate an optical center ofthe aiming-beam radiation (aiming beam) that is projected onto theoutput fiberoptic. It can be discerned from the figure, in accordancewith an aspect of the invention, that the projection of aiming-beamradiation is not centered on the output fiberoptic, as a consequence ofthe depicted circles not being concentric and the cross-hairs havingdifferent positions. In modified embodiments, the spot size, opticalcenter as projected onto the output fiberoptic, and/or angle ofincidence onto the output fiberoptic, of the aiming beam may be variedto introduce more or less aiming-beam light into the ferrule and/or intothe output fiberoptic.

The aiming beam can comprise a wavelength of about 635 nm and, as itexits the window 114, can have a power of about 1 to 3 mW and a spotsize of about 600 microns. As indicated in FIG. 12 and in the lower-leftdepiction of FIG. 12H, the aiming beam can be configured and routed toimpinge on the output fiberoptic 107 at an angle, such as at an angle ofabout 15 degrees with respect to an optical axis of the outputfiberoptic. The aiming beam may comprise one or more of continuous wave(CW) and modulated energy.

According to an aspect of the present invention, the aiming beam can beoperated in a modulated mode at lower output (e.g., brightness) settingsand a CW mode at higher output (e.g., brightness) settings. As anexemplary embodiment, the aiming beam when modulated may comprise (1) amodulation frequency of about 50 Hz corresponding to a pulse period ofabout 20 ms, (2) a peak power of about 2 mW, and (3) a pulse duty cycle,defined as the pulse duration divided by the pulse interval, rangingfrom about 5% to about 70%. A particular implementation may comprisefirst, second, third and forth presets that output an aiming beam, withany one or more of the above-mentioned aiming beam parameters, withpulse duty cycles of 5, 10, 30 and 70, respectively, and may furthercomprise a fifth preset that outputs an aiming beam, with one or more ofthe above-mentioned aiming beam parameters, in a CW mode.

Another aspect of the present invention introduces structure and/oralgorithms for altering a visual, structural, or functionalcharacteristic of one or more of the ferrule 112, output fiberoptic 107,or any other component described herein (e.g., the display), to therebyprovide an indication to the user, following a predetermined number ofuses or amount of time of use of the output fiberoptic 107. Theindication communicates to the user that the output fiberoptic 107(e.g., the entire replaceable output tip 108) should be replaced.Feedback light can used to detect a change in feedback beam qualitycorresponding to a degradation (e.g., fraying) of a distal-most outputend of the output fiberoptic 107, the detection of which can trigger anoccurrence of the indication. The indication can also be triggered bythe occurrence of an autoclave procedure (for a single use limitation)or of a predetermined number of autoclave procedures (for a multiple-uselimitation), after which the output fiberoptic tip 107 should bereplaced wherein an adhesive used in the output fiberoptic 107 can beselected to degrade or disintegrate when subjected to the autoclaveprocedure or procedures. In another implementation, the ferrule 112 cancomprise a material that changes color after a predetermined amount ofuse time has occurred, thus providing the indication.

The output surface of the aiming beam fiber 115 can be truncated andpolished at a non-normal angle so that the output surface directs theaiming beam into the center of the output fiberoptic 107. A point on theoutput surface of the aiming beam fiber 115 intersected by the opticalaxis of the aiming beam fiber 115 can be referred to as an output point.With reference to FIG. 12, the angle A2 between the optical axis of theaiming beam fiber 115 and a path of output energy directed from theoutput point into the center of the output fiberoptic 107 may, forexample, be from about 10 to 20 degrees in an implementation wherein thecenter-to-center separation between the trunk optical fiber 73 and theaiming beam fiber is about 130 to 150 microns and the distance from theoutput end of the trunk optical fiber 73 to the input end of the outputfiberoptic 107 is about 300 to 700 microns. With regard to theillumination pattern shown in FIG. 13, a center 74 of the ring is filledwith irradiation from the trunk optical fiber 73, and the ring pattern76 corresponds to radiation from the aiming beam fiber 115. With thisirradiation pattern, a quality of the ring pattern can be used todetermine a quality of the beam or beams.

A core diameter of the trunk optical fiber 73 can be, for example, about105 microns, and a core diameter of the output fiberoptic 107 can be,for example, about 200, 300 or 400 microns. As embodied herein, thewindow 114 can comprise sapphire with an anti-reflective coating (ARC)on one or both of its sides. In a particular implementation, it cancomprise a thickness of about 250 microns and a diameter of about 2.5mm, and can have an ARC disposed on both of its circular surfaces. Otherstructures and materials may be implemented in modified embodiments,and, according to certain aspects, such modifications can maintain afunctionality of the optical interface of providing a thermal and/orthermal barrier while providing an optical pathway between the trunkoptical fiber 73 and the output fiberoptic 107. For example, a functionof the optical interface can be to dissipate heat to protect the trunkoptical fiber 73 output end from damage.

FIG. 14 provides examples of a number of typical bendable tip cannulas,comprising ferrules, which may comprise different colors to indicatedifferent characteristics, and which may be interchangeably affixed tothe handpiece 78.

As with typical prior-art implementations, the distal energy output endof the output fiberoptic 107 can exhibit signs of wear or damage afteruse (e.g., after about 5 minutes of actual lasing time), and thus shouldbe replaced on a frequent and regular basis. The replaceable output tip108 of the present invention can render such replacements rapid,reliable, efficient, sterile, and convenient. A typical cannula of theinvention, such as a typical bendable tip cannula 109, may comprise aone millimeter OD, a 0.1 millimeter wall thickness, and a 2.5 centimeterlength, with an inner lumen of the cannula accommodating an outputfiberoptic having, for example, a 400 micron diameter, whereby a lengthof the output fiberoptic protruding distally from the cannula may be,for example, about four to nine millimeters.

With reference to FIG. 15, an electromagnetic energy output device isexemplified in the form of a body-mount implementation. Thebody-attachment (e.g., wrist mount) implementation of theelectromagnetic energy output device 141 can comprise a housing 143 witha body attachment (e.g., a wrist band) 145, a fiber optic 148, and anoutput configuration. The housing can comprise, for example, a display,such as a touchscreen 156, inputs or controls 159, an electromagneticenergy source such as a laser 161, and batteries 164 which may comprisetwo sets of batteries. The output configuration is embodied in thisexample as a handpiece 151 with an actuator control 152 for controlling,for example, an on/off state of an electromagnetic energy source (e.g.,laser) and with a fiber optic tip 153.

FIGS. 16 and 17 show perspective front and rear views of anelectromagnetic energy output device 171 in the form of a compact,portable assembly that can be carried or mounted with relative ease by auser. The electromagnetic energy output device 171 can comprise ahousing 173 with a removable base 175 and a removable spool 177. Theremovable base 175 can be detachably secured to the housing 173 usingany known means for providing a removable affixation, such as, referringto FIG. 19, a protuberance or rib 179 of the base 175 constructed toslidably fit into a slot or channel 181 of the housing 173. Inoperation, a user can lift the housing 173 above the removable base 175so that the channel 181 is positioned above the rib 179, as exemplifiedin FIG. 19. Subsequently, the user the user can lower the housing 173 insuch a way that the channel 181 contacts, is moved around, and envelopsat least a part of the rib 179, until the housing 173 is positioned onthe same plane (e.g., table top) on which the removable base 175 rests.

According to the embodiment of FIGS. 16 and 17, the electromagneticenergy output device 171 further comprises a fiber optic 176, whichextends from a point of the housing 173 to the removable spool 177 andwhich further extends to an output configuration 180. The outputconfiguration 180 is embodied in this example as a handpiece 151 havingan actuator control (not shown) for controlling, for example, an on/offstate of an electromagnetic energy source (e.g., laser) and furtherhaving an output fiberoptic which in the illustrated embodimentcomprises a replaceable output tip 183. A foot switch can be used inlieu of the actuator for turning the laser on and off, and it cancommunicate with the housing 173 using a wireless communicationprotocol, such as Bluetooth® technology.

The electromagnetic energy output device 141 can be hand-held as can beseen with reference to FIG. 20B. The electromagnetic energy outputdevice 141 can also be wall or pole mounted as shown in FIG. 18, orpositioned on a table top as elucidated, for example, in FIGS. 16, 17,19 and 20A.

The housing 173 can comprise, for example, a display, such as atouchscreen 156, inputs or controls 159, an electromagnetic energysource such as a laser (not shown), and batteries (not shown) which maycomprise two sets of batteries. The electromagnetic energy source can bedisposed in a lower, rear portion of the housing 173. A power chord canbe implemented as an alternative, or in addition to, the batteries. In amodified embodiment, one or more of a size, shape and capacity of theremovable base 175 may be altered or enhanced to form an altered orenhanced removable base 175. An example of an altered base, such asdiscussed below and shown in FIGS. 26A and 26B, may be formed andimplemented for carrying the laser and/or one or more additional,optional lasers. As shown in FIGS. 21, 22, and others, when theremovable spool 177 is disposed (e.g., attached) in close proximity tothe housing 173, an extra length (e.g., one foot) of fiber optic 176 canbe stored in a trip-free (e.g., of reduced clutter) and organizedfashion. In modified embodiments, the removable spool 177 can be securedto (and, in other modified embodiments, secured and concealed, forexample, within) the housing 173), to thereby provide a technician oruser with a means of increasing a length of the fiber optic 176 byadvancing additional fiber optic 176 from the removable spool 177 towardthe handpiece 151 should the need arise. In a modified embodiment, theremovable spool 177 can be disposed, but not necessarily attached,outside of the housing 173 and/or in a vicinity of (e.g., adjacent to orinside of) the handpiece 151. Using this technique, a fiber optic 176length of, for example, 5 to 8 feet can be maintained in the event ofdamage, such as an overheating occurrence of the optical interface.

In accordance with an aspect of the current invention, the functionalityprovided by the disclosed arrangement can be accomplished without thenecessity of having the fiber optic 176 slidably disposed within thebendable tip cannula 109. Accordingly, and in contrast to the prior-artconstruction of FIG. 1, the output fiberoptic 107 can be permanentlyaffixed, such as by an adhesive, within the bendable tip cannula 109.

FIG. 26A depicts a particular implementation of a touchscreen and inputsor controls, wherein, for example, the center (e.g., 19.50w) display hasleft-facing and right-facing arrows for increasing and decreasingvarious parameters; here power is shown and the dark shaded part on thehemispherical dial shows graphically the degree of that setting comparedto the maximum value (cf. a speedometer). An Energy Start display canshow how much energy has been delivered total, and can be reset to zeroafter each use. The Energy Start feature does not have a cap and countsthe energy delivered. An Energy Total feature, on the other hand, cancount down from a preset total amount to be delivered.

The Energy Total display can be programmed (or chosen from a preset) tospecify a total amount of energy (e.g., deliver in one periodontalpocket 5-10 J; for example, it may take 10-15 seconds and typically willbe one continuous shot, to be delivered). If too much energy isdelivered, for example, overheating and/or removal of too much tissuemay occur; the user typically cannot see within the periodontal pocket,for example, and, furthermore, the patient may not be able to feel thepain in an overdose situation.

Average Power can be calculated in real-time and displayed in J/s. Whilethe figures depict a touchscreen, the functionality of the currentsystem can also be obtained using the user-interface inputs at thebottom of the unit comprising an Enter input and four arrow inputs. Thedepicted assembly can be wall mounted, wrist mounted (e.g., with abattery, with fewer hard (physical) buttons and more of adisplay/software driven user interface, and shorter cables/fibers) asexemplified in the depiction and discussion regarding FIG. 15, or beltmounted.

The removable spool 177 can comprise, for example, two parts, as shownin FIGS. 23 and 24, to provide storage and protection to the fiber optic176. In the exemplary implementation shown in FIGS. 21-25B, theremovable spool 177 comprises a spool enclosure 177A and a rubberenclosure 177B. The rubber enclosure 177B can comprise a rubber hub, asdepicted, which clips onto the spool enclosure 177A and which controlswinding and unwinding of the fiber optic 176. A domed interior of thespool enclosure 177A allows coils of the fiber optic 176 to expand inthe chamber. With reference to FIG. 24, in certain implementations fiberoptic 176 which is wrapped around the removable spool 177 is unspooledand released as a user pulls the handpiece away from the removable spool177. Referring to FIG. 25A, during winding, the rubber enclosure 177B(e.g., rubber hub) directs windings of the fiber optic 176 inward andsupplies containment pressure. Referring to FIG. 25B, it can be seenthat, during unspooling, pulling of optical fiber 176 out of the spoolcauses the rubber enclosure 177B (e.g., rubber hub) to deflect away fromthe spool enclosure 177A, allowing the fiber optic 176 within theremovable spool 177 to spill out automatically so that the user does notneed to manually unwind the fiber optic 176 from the removable spool177.

The laser module 69 of, for example, FIGS. 25A and 25B, can comprise adiode laser. The diode laser of the system can be disposed near thebottom of the housing 173, and the removable base 175 can serve as aheat sink. Additional lasers can be added into the bottom of the housing173, into the base 175, and/or, according to the modified implementationshown in FIGS. 26A and 26B, referenced above, a base 186 can be formed(e.g., restructured, as shown, to provide a larger interior) to providea greater volume for the additional lasers. Also, the base 186 can beformed to have extra ribs or other heat dissipating structures.

In view of the foregoing, it will be understood by those skilled in theart that the methods of the present invention can facilitate formationof laser devices, and in particular diode laser systems. Theabove-described embodiments have been provided by way of example, andthe present invention is not limited to these examples. Multiplevariations and modification to the disclosed embodiments will occur, tothe extent not mutually exclusive, to those skilled in the art uponconsideration of the foregoing description. Such variations andmodifications, however, fall well within the scope of the presentinvention as set forth in the following claims. Additionally, othercombinations, omissions, substitutions and modifications will beapparent to the skilled artisan in view of the disclosure herein. Asiterated above, any feature or combination of features described andreferenced herein are included within the scope of the present inventionprovided that the features included in any such combination are notmutually inconsistent as will be apparent from the context, thisspecification, and the knowledge of one of ordinary skill in the art.For example, any of the lasers and laser components including outputconfigurations, and any particulars or features thereof, or otherfeatures, including method steps and techniques, may be used with anyother structure and process described or referenced herein, in whole orin part, in any combination or permutation. Accordingly, the presentinvention is not intended to be limited by the disclosed embodiments,but is to be defined by reference to the following additional disclosurein claims format.

1. An apparatus, comprising: an excitation source comprising at leastone laser diode within a system; and a handpiece comprising (a) adisposable, bendable tip cannula, (b) an output fiberoptic operativelycoupled to the excitation source and extending at least partiallythrough the bendable tip cannula, the output fiberoptic having aproximal end aligned to receive electromagnetic energy from theexcitation source and a distal end adapted to emit the electromagneticenergy away from the handpiece, and (c) a region having a position in avicinity of the proximal end, an opacity that is less than that of thebendable tip cannula, and a construction that causes an appearance ofthe region to change when the output fiberoptic emits theelectromagnetic radiation from the distal end.
 2. The apparatus as setforth in claim 1, wherein the excitation source is a laser module withinthe system.
 3. The apparatus as set forth in claim 1, wherein theexcitation source is directly coupled to a trunk optical fiber, and thetrunk optical fiber is permanently coupled to the system.
 4. Theapparatus as set forth in claim 1, wherein the system is a diode lasersystem, and the excitation source is directly and permanently coupled toa trunk optical fiber.
 5. The apparatus as set forth in claim 1, whereinthe system is a diode laser system, the excitation source is a lasermodule within the system that is directly coupled to a trunk opticalfiber, and the trunk optical fiber extends continuously and withoutinterruption, interface, or coupling from a permanent connection at thelaser module all of the way to the handpiece.
 6. The apparatus as setforth in claim 1, wherein (a), (b) and (c) form a disposable output tipthat is removably connected at a distal end of the handpiece, andwherein the apparatus further comprises a trunk optical fiber thatextends continuously and without interruption, interface, or couplingfrom a permanent connection at the excitation source all of the way to,and through at least a part of, the handpiece.
 7. The apparatus as setforth in claim 1, wherein (a), (b) and (c) form a disposable output tipthat is removably connected at a distal end of the handpiece, andwherein the apparatus further comprises a trunk optical fiber thatextends continuously and without interruption, interface, or couplingfrom a permanent connection at the excitation source all of the way tothe handpiece and through substantially all of the handpiece, andterminates at the distal end of the handpiece.
 8. The apparatus as setforth in claim 1, wherein the apparatus is configured to output laserenergy having a wavelength of about 915 microseconds, about 940microseconds, about 960 microseconds, or about 980 microseconds, andwherein the apparatus is configured to output the laser energy in acontinuous wave or quasi-continuous wave mode.
 9. The apparatus as setforth in claim 1, wherein the apparatus is configured to output pulsedlaser energy with a pulse duration and a pulse interval that are both onthe order of microseconds.
 10. The apparatus as set forth in claim 1,wherein the apparatus is configured to output pulsed laser energy with apulse duration of about 50 microseconds or less and a pulse interval ofabout 450 microseconds or more.
 11. The apparatus as set forth in claim1, wherein: the apparatus is configured to output pulsed laser energywith an independently adjustable pulse duration that can be adjustedindependently of the pulse interval.
 12. The apparatus as set forth inclaim 1, wherein: the apparatus is configured to output pulsed laserenergy with an independently adjustable pulse interval that can beadjusted independently of the pulse duration.
 13. The apparatus as setforth in claim 1, wherein: the pulse duration may be varied by a userwithout varying the pulse interval and wherein the pulse interval may bevaried by a user without varying the pulse duration.
 14. The apparatusas set forth in claim 1, wherein: the pulse duration may be varied by auser to a greater or lesser degree than a varying the pulse interval andwherein the pulse interval may be varied by a user to a greater orlesser degree than a varying the pulse duration.
 15. The apparatus asset forth in claim 1, wherein the proximal end of the output fiberopticis at least partially surrounded by the region.
 16. The apparatus as setforth in claim 1, wherein the bendable tip cannula is constructed not toglow when the output fiberoptic emits the electromagnetic radiation fromthe distal end.
 17. The apparatus as set forth in claim 1, wherein theregion is a ferrule.
 18. The apparatus as set forth in claim 1, whereinthe excitation source is configured to output an aiming beam and theregion is a ferrule that glows with a color of the aiming beam.
 19. Theapparatus as set forth in claim 1, wherein the ferrule has a cleartransparency corresponding to a color and transparency of water.
 20. Theapparatus as set forth in claim 1, wherein the ferrule has atransparency with a slight hue of one or more colors.